15291 (RR)j w P.O. BOX 1504-\
No. 15291.
Building 78-495 CALLE TAMPICO
Address 80-080 Vista Grande LA OUINTA, CALIFORNIA 92253
Owner
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE'. INTEREST, AND.'
Rutledge
ATTORNEY'S FEES. -�>e
Mailing
BUILDING: TYPE CONST..
.
OCC: GRP.
Address SaT e
I certify that I have read this application and'state that the above information is correct.
Issued by:—
I agree to comply with all city and county ordinances and state laws, relating to building
A.P. Number
construction, and hereby authorize representatives -of this city to enter the above-.
City •
Zip
Zip
Tel.
Signature of applicant Date
La. Qui�°At�a CA
_ Validation:_
City, State, Zip "
Legal Description
Contractor
Project Description Rer®of
C.V. kaofing
Address _
P.O. Box -1256
C'ty ..
Ad10F CA
Zip
92202
Tel
.398-5186
State Lic.
City
& Classif.. 352007
Lic. # 37.9
Sq. Ft. No. . -
No. Dw.
Size - Stories
Units. .. -.
' Arch., Engr.,
Designer .
"
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition. ❑
Address
Tel.
City
Zip
State
Lic.'#'
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisigl�s of Chapter 9 (commencing with Section
)7000) of Divi'sioh loffthirBusine rid Professions/Code, and my license 's in full force and �'
"effect. 6
3LGNATURE - a DATE
'
" OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following,
��Q. ��
reason: (Sec. 7031.5,Susiness and Professions Code: -Any city. or -county which requires a
•
permit to construct, alter. Improve, demolish, or repair' any structure, prior to its issuance also
-
requires the applicant for such permit to rile a signed statement that he is licensed -pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep.
'
'
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).•
Plan Chk. Bal.
❑ I, as.owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
30.00
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
' Mech.
'
provided that such improvements are not Intended or.oHered for sale. If,•however,the building
•or Improvement Is sold within one year of completion, the owner -builder will have =the burden
- EI2CtrICdl '
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with -licensed contractors to con
Plumbing
' struct the project. (Sec. 7044, Business and -Professions, Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who'contracts for .
such projects with a contractors) jtcensed pursuant to the Contractor's License Law:) -
S.M.I.
. > Y
❑ ham exempt under Sec. B. & P.C. for this reason
Grading
.
Driveway Enc.."_
Date Owner
infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of gonsen to self -insure, or a certificate of
Worker's Compens�ationesuranee, or a certifed�cdpy thtf..(Sec. 3800, Labor Code.)
Policy No ! �. f 8 many ir. i/ �' 0.
py is filed with the city. O Certified copy is hereby furfished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need 'not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any
Californiaperson in any manner so as to become subject to the Workers' Compensation
Laws of .
Dale Owner
NOTICE TO APPLICANT:- g, after making this Certificate of Exemption you should become
subject to 'the Workers' Compensatkm provisions of -the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. f
TOTAL / 30.00
REMARKS
ZONE:
Minimum"Se
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
'
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE '
HUNDRED THOUSAND DOLLARS ($100,01)0), IN ADDITION TO THE ,COST OF COMPENSATION, '
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE'. INTEREST, AND.'
ATTORNEY'S FEES. -�>e
This"is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE,
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and'state that the above information is correct.
Issued by:—
I agree to comply with all city and county ordinances and state laws, relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
_
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
_ Validation:_
City, State, Zip "
.w
. BY:
Distances:
_Front Setback from Center -Ll
_Rear Setback from Re�Pr• p. Lin
_Side Street Setback. m Center
_Side Setback from eropertwkine_
t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR . SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE .
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. .
BONDING
'HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
'
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
�•
ROOFING `/J•Vj
I !J
VENTILATION
REMARKS:
.
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S S16NATURESIINITIALS
GARDEN WALL FINAL